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Linear immunoglobulin A bullous dermatosis (LABD) is a rare chronic disease, but it is the most frequent auto-immune bullous disease in children (1). In this age group, the eruption is characterized by a clustered arrangement of blisters, located mainly on the lower abdomen, perineum, and perioral area (2). In adults, the eruption is polymorphic, with no specific anatomical sites, and can simulate other auto-immune bullous diseases (1). Functional symptoms vary from mild pruritus to severe burning. Histological examination reveals a dense superficial dermal infiltrate made of neutrophils and eosinophils in the form of micro-abscesses on top of papillae, together with dermo-epidermal detachment. LABD is caused by IgA auto-antibodies typically directed against a proteolytic fragment of 180-kDa bullous pemphigoid antigen (BP180) detected as a 97 or 120 kDa protein on western blotting, and/or other components of the dermal–epidermal junction (3). Direct immunofluorescence is characterized by linear IgA deposits on the basal membrane. First-line treatment for LABD is dapsone, used as monotherapy or in combination with systemic corticosteroids. For patients not responding to dapsone, sulphapyridine, immunosuppressive drugs, immunoglobulins or rituximab have been advocated (4). We report here the efficacy of botulinum toxin A (BtxA) injections for LABD located in the axillae.

Botulinum Toxin A: An Effective Treatment for Linear Immunoglobulin A Bullous Dermatosis Located in the Axillae